scholarly journals BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

Pharmacy ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 145
Author(s):  
Maressa Santarossa ◽  
Emily N. Kilber ◽  
Eric Wenzler ◽  
Fritzie S. Albarillo ◽  
Ethan J. Sterk
Keyword(s):  
Emergency Department ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Respiratory Infections ◽  
Narrative Review ◽  
Multiple Infection ◽  
Care Bundles ◽  
Sexually Transmitted ◽  
Infection Types ◽  
Tract Infections

Antimicrobial stewardship (ASP) is becoming an increasingly high priority worldwide, yet the emergency department (ED) is an area where stewardship is often neglected. Implementing care bundles, guidelines, and protocols appears to be a rational strategy for ED stewardship given the inherently dynamic and hectic environment of care. Multiple questions still exist such as whether to target certain disease states, optimal implementation of ASP interventions in the ED, and the benefit of unique ED-specific guidelines and protocols. A narrative review was performed on interventions, guidelines, and bundles implemented in the ED setting, in an effort to improve ASP or management of infectious diseases. This review is meant to serve as a framework for the reader to implement these practices at their own institution. We examined various studies related to ASP interventions or care bundles in the ED which included: CNS infections (one study), skin and soft-tissue infections (one study), respiratory infections (four studies), urinary tract infections and sexually transmitted infections (eight studies), sepsis (two studies), culture follow-up programs (four studies), and stewardship in general or multiple infection types (five studies). The interventions in this review were diverse, yet the majority showed a benefit in clinical outcomes or a decrease in antimicrobial use. Care bundles, guidelines, and antimicrobial stewardship interventions can streamline care and improve the management of common infectious diseases seen in the ED.

scholarly journals 1116. Impact of Antimicrobial Stewardship Incentive Goals for Pharmacists on Overall Antibiotic Use and Appropriate Duration of Therapy in Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S397-S397
Author(s):  
Matthew A Miller ◽  
Mattie Huffman ◽  
Nichole Neville ◽  
Misha Huang ◽  
Gerard Barber
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Stewardship ◽  
Group Performance ◽  
Respiratory Infections ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Days Of Therapy ◽  
Essential Resource ◽  
Tract Infections

Abstract Background Urinary tract (UTI), skin and soft tissue, and respiratory infections are among the most frequently reported indications for antibiotics, such that focusing stewardship efforts here would expectedly have dramatic effects. Antimicrobial stewardship (AMS) programs vary in structure and available resources. At the University of Colorado Hospital, a 740-bed academic medical center, dedicated resources for AMS are limited to a pharmacist, pharmacy resident, and physician; however, there is a large clinical pharmacist group. For the past 2 years, pharmacy management incorporated AMS targets as group goals tied to performance bonuses. Methods This is a descriptive report utilizing incentives to achieve AMS goals. The first goal (July 1, 2016 to June 30, 2017) set out to reduce inpatient antibiotic use by 10%. The second goal (July 1, 2018 to June 30, 2018) was a 10% reduction in median antibiotic duration for UTIs. The AMS team provided guidelines, education, and oversight throughout target periods. Antibiotic use was calculated as days of therapy (DOT) per 1000 patient-days. Data related to UTI treatment was collected retrospectively on a quarterly basis. This was compared with baseline data previously collected during a statewide hospital stewardship collaborative project. Results During the first period, overall antibiotic use declined from 497 to 403 DOT per 1000 patient-days (18.9%), and broad-spectrum antibiotic use declined 22%. During the second period, 30 patient charts were reviewed quarterly, and the median UTI duration declined from 10 to 7 days (P = 0.002). The most common UTI diagnoses were similar between periods with complicated cystitis and pyelonephritis comprising 60–70% of cases. The 30-day readmission rate was not different between the baseline and goal period, 11% vs. 6% respectively (P = 0.18). Conclusion The use of group pharmacist goals tied to annual performance bonuses was effective in achieving AMS goals at our institution. In larger facilities with fewer dedicated AMS personnel, clinical pharmacists covering ward and intensive care units are an essential resource to achieving AMS goals. Group performance incentives may be a feasible strategy to generate interest and motivation to achieve AMS program goals. Disclosures All authors: No reported disclosures.

LO91: Urinary tract infections in the paediatric emergency department: A quality improvement initiative to promote diagnostic and antimicrobial stewardship

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S41
Author(s):  
V. Singh ◽  
L. Morrissey ◽  
M. Science ◽  
O. Ostrow
Keyword(s):  
Emergency Department ◽  
Urinary Tract ◽  
Antimicrobial Stewardship ◽  
Urine Culture ◽  
Diagnostic Algorithm ◽  
Antimicrobial Treatment ◽  
Stewardship Program ◽  
Common Diagnosis ◽  
Negative Urine Culture ◽  
Tract Infections

Background: Urinary tract infection (UTI) is a common diagnosis in children presenting to the Emergency Department (ED) and often leads to empiric antibiotic treatment prior to culture results. A recent study at our centre found that 47% of children diagnosed with a UTI and discharged on antibiotics had a negative urine culture. None of these patients were notified of the negative result or to discontinue antimicrobial treatment. Aim Statement: The aim of this study was to improve UTI diagnostic accuracy by 50% while promoting antimicrobial stewardship through timely antibiotic discontinuation and standardized antimicrobial treatment for uncomplicated UTIs over the next 12 months. Measures & Design: Three interventions were developed using plan-do-study-act (PDSA) cycles. In collaboration with the hospital's Choosing Wisely campaign and antimicrobial stewardship program, an evidence-based empiric UTI diagnostic algorithm was created to aid with diagnostic decision-making and reduce practice variation. A daily call-back system was also implemented for urine cultures where patients who had a negative urine culture were contacted to stop antibiotics. Lastly, a practice alert was integrated in the EMR as a reminder of appropriate antimicrobial prescription duration. The main outcome measures were the percentage of inappropriately diagnosed UTIs and percentage with timely antimicrobial discontinuation. Process measures included antibiotic days saved, treatment duration, and physician adherence to the algorithm. As a balancing measure, positive urine cultures were reviewed to assess accuracy of the algorithm to detect UTIs and potential harm from delayed UTI diagnoses. Evaluation/Results: Early results from the 530 children included in the analysis demonstrated a 14% reduction in inappropriate UTI diagnoses. With the initiation of the call-back system, the antibiotic days saved increased from 0 to 495 days. Call-backs for negative cultures increased from 0% to 68% of the time. Of those positive cultures with a missed UTI diagnosis, only 5 patients in 5 months had a return visit within 72 hours and none required admission. Discussion/Impact: Appropriate diagnosis and treatment of UTIs in our ED has improved with the implementation of a diagnostic algorithm. A larger impact is anticipated once the algorithm is embedded in the EMR as a form of decision support, but these changes take time to implement. Although labour intensive, the call-back system has greatly impacted the antimicrobial days saved and reduced risk for harm in this population.

Antimicrobial Stewardship in the Emergency Department

2016 ◽  
Vol 29 (6) ◽  
pp. 556-563 ◽  
Author(s):  
Bryan M. Bishop
Keyword(s):  
Emergency Department ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Health Concern ◽  
Antimicrobial Use ◽  
Upper Respiratory Infection ◽  
Diagnostic Uncertainty ◽  
National Public Health ◽  
Inpatient Settings ◽  
Tract Infections

Antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few. However, this review article highlights successful interventions that have stemmed inappropriate antimicrobial use in the ED setting and warrant further study. This article also proposes other, yet to be validated proposals. Finally, this article serves as a call to action for pharmacists working in antimicrobial stewardship programs and in emergency medicine settings. There needs to be further research on the implementation of these and other interventions to reduce inappropriate antimicrobial use to prevent patient harm and curb the development of antimicrobial resistance.

scholarly journals Epizootiology of Infectious Diseases of Dog in Some States in Nigeria (2015–2018)

2019 ◽  
Vol 21 (96) ◽  
pp. 33-40
Author(s):  
M. T. Tion ◽  
G. A. Zon ◽  
H. A. Fotina ◽  
K. I. Ogbu ◽  
S. A. Nguetyo ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Infectious Diseases ◽  
Urinary Tract Infections ◽  
Respiratory Infections ◽  
Disease Incidence ◽  
Dry Season ◽  
Canine Distemper ◽  
Indigenous Breed ◽  
Tract Infections ◽  
Clinical Cases

An epizootiology of infectious diseases/conditions of dog in some veterinary clinics from Benue, Plateau states and the Federal Capital Territory in Nigeria were assessed from 2015 to 2018. This study revealed about seventeen (17) infectious clinical cases/conditions from 1865 cases recorded within the period of four (4) years. These comprised of helminthoses (17.8%) having the highest prevalence followed by babesiosis (17.5%), parvovirosis (15.9%), ectoparasitism (11.3%), scepticemia (6.9%), Mange (5.7%), urinary tract infections (4.7%), canine distemper (4.2%), colitis (3.9%), myiasis (2.7%), trypanosomosis (2.1%), leptospirosis and transmissible venereal tumor (1.9%), respiratory infections (1.7%), otitis (1.0%) and orchitis (0.7%). Puppies (0–6 months old) 50.2% were mostly affected. Incidences of diseases were more in Alsatians (23.7%), Cross (22.9%), Nigerian indigenous breed (20.5%), Caucasian (9.6%) and Rottweiler (8.9%). More cases of vaccinated (68.7%) were recorded against the unvaccinated (31.3%) dogs while male (57.1%) dogs had a higher frequency of cases as compared with their female (42.9%) counterpart. Disease incidence was highest in dry season (54.3%) especially in the months of December (13.3%), January (11.1%) and February (10.6%).The highest frequency of disease incidence was recorded in 2015 (36.4%). Most the infectious clinical cases/conditions recorded from this study were preventable cases demanding veterinary care in order to prevent the risk of zoonosis.

Clinical Syndromes in Infectious Diseases

2012 ◽  
Author(s):  
Robert Orenstein
Keyword(s):  
Urinary Tract ◽  
Infective Endocarditis ◽  
Soft Tissue ◽  
Infectious Diseases ◽  
Sexually Transmitted Infections ◽  
Soft Tissue Infections ◽  
Gastrointestinal Infections ◽  
Sexually Transmitted ◽  
Clinical Syndromes ◽  
Tract Infections

This chapter approaches the field of infectious diseases from 3 perspectives. This second part covers clinical syndromes associated with various infections, such as infective endocarditis, meningitis, sexually transmitted infections, urinary tract infections, gastrointestinal infections, and soft-tissue infections. Symptoms, diagnosis, and treatment of these conditions are reviewed.

scholarly journals Acute Respiratory Infections (ARI) and Weaning Status of Infants Admitted in Selected Hospitals of Rajshahi- A Case Control Study

2019 ◽  
Vol 32 (1) ◽  
pp. 70-81
Author(s):  
Farhana Yasmin ◽  
Md Jawadul Haque
Keyword(s):  
Infectious Diseases ◽  
Respiratory Tract ◽  
Breast Feeding ◽  
Respiratory Tract Infections ◽  
Respiratory Infections ◽  
Case Control ◽  
Case Group ◽  
Acute Respiratory Infections ◽  
Wide Range ◽  
Tract Infections

Background: Acute respiratory infections (ARI) include upper respiratory tract infections and lower respiratory tract infections. Infections of the respiratory tract are perhaps the most common human ailment. While they are a source of discomfort, disability and loss of time for most adults, they are a substantial cause of morbidity and mortality in young children. ARI may cause inflammation of the respiratory tract anywhere from nose to alveoli, with a wide range of combination of symptoms and signs. ARI in children is most common among others because heir constant contact with other kids who could be virus carriers. Children often don’t wash their hands regularly. They are also more likely to rub their eyes and put their fingers in their mouths, resulting in the spread of viruses. For prevention of malnutrition and infection of child breast feeding is an important determinant of child health in the prevention of malnutrition and infection but in many cultures other food was introduced years before the cessation of breast feeding. In Bangladesh, many infectious diseases such as diarrhoea and acute respiratory infections are the main cause of mortality and morbidity in infants aged less than one year. The importance of breast feeding in the prevention of infectious diseases during infancy is well known. Objective: In this study our main objective is to evaluate the association between ARI of infant and weaning status of infants admitted in selected Hospitals of Rajshahi. Study place and Method: This study provided a wide range of information regarding ARI and weaning status of infants admitted in selected hospitals of Rajshahi and from the surroundings. This was a case control type of study. A total of 230 caregiver or mothers were interviewed. Result & discussion: It was found that the relationship between weaning status of infants and occurrence of ARI was statistically significant (p<0.001). It was showed that majority of the babies of the case group were weaned by Cow’s milk and within the control group by mashed rice. The association between occurrence of ARI and type of weaning food was statistically significant (p<0.001). It was also found that majority of the babies living in rural areas developed ARI and also within the case group majority (29.6%) of the babies who were not exclusively breast fed developed ARI and the association between occurrence of ARI and EBF was statistically significant (p<0.001). Conclusion: Our study suggests that proportion of ARI is more among the infants who were weaned earlier. TAJ 2019; 32(1): 70-81

Infectious Diseases Questions and Answers

2013 ◽  
pp. 45-58
Author(s):  
Robert D. Ficalora
Keyword(s):  
Urinary Tract ◽  
Infectious Diseases ◽  
Travel Medicine ◽  
Soft Tissue Infections ◽  
Mycobacterial Infections ◽  
Sexually Transmitted ◽  
Joint Infections ◽  
Questions And Answers ◽  
Board Review ◽  
Tract Infections

Chapter 5 presents multiple-choice, board review questions on infectious diseases including travel medicine, zoonoses, bioterrorism, pneumonia, mycobacterial infections, skin and soft tissue infections, bone and joint infections, urinary tract infections, sexually transmitted infections, gastrointestinal tract infections, and HIV infection. Full explanations are provided with the correct answers.

Renal and Genitourinary Emergencies

2019 ◽  
pp. 293-303
Author(s):  
Michelle Storkan
Keyword(s):  
United States ◽  
Emergency Department ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Sexually Transmitted Infection ◽  
The United States ◽  
Common Reason ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Tract Infections

Renal and genitourinary complaints are common presentations to the emergency department. Urinary tract infections are among the top three sites of infection in patients presenting to the emergency department. Nephrolithiasis is also a common reason for patients to present due to the severe associated pain. Greater than 20 million patients in the United States are diagnosed with a sexually transmitted infection yearly and many of these present to the emergency department due to the associated discomfort and related symptoms. Other conditions related to the renal and genitourinary systems, though less common, are important for emergency providers to be adept at managing.

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